Abstract P163: Live Well: An Effective Physician-Delivered Low-Intensity Dietary Counseling Intervention for Patients with Dyslipidemia
Background: Approximately 16% of U.S. adults have elevated total cholesterol levels >200 mg/dl and diet is the first line treatment. Clinical guidelines recommend high-intensity behavioral dietary counseling (>360 minutes/year). Low-intensity counseling trials (< 30 minutes/year) have demonstrated modest diet changes, but no improvement in lipid profiles.
Objective: To evaluate the effects of an innovative low-intensity dietary counseling intervention provided by the primary care physician (PCP) on LDL-cholesterol, other lipid subclasses, and diet quality, in adult outpatients with LDL-cholesterol > 130 mg/dL, having internet access and an active email account.
Methods: Three month randomized controlled trial (group A - intervention, group B -control) of dietary counseling provided by the PCP during a single routine office visit using printed materials and a minimally interactive website. Weekly emails were sent to intervention group subjects reminding them to log into the counseling website. No additional patient counseling support (in person, by phone, or email) was provided. Diet was evaluated at baseline and three months using an electronic version of the Rate-Your-Plate (RYP) questionnaire. The RYP results were displayed using a color coded chart that allowed for easy identification of dietary patterns. The original RYP classifies diet quality as poor, fair, and good. To motivate patients toward the best cholesterol-lowering diet, we divided the “good” category into “good” and “very good” and promoted change toward “very good” by creating four diet quality levels. Fasting lipids were collected at baseline and three months.
Results: Participants were 61 adults aged 21 to 75 years. At baseline there were no statistically significant differences between the two groups in regard to diet quality (very good, good, fair, poor): χ2(2) = 4.7, P = 0.09. At three months, diet quality in group A improved significantly compared with group B, χ2(3) = 10.652, P = 0.01: the percentages of very good, good, fair and poor diet were 16.5, 41.9, 41.9 and 0 in group A, versus 0, 17.2, 72.4 and 6.9 in group B. Compared with group B, group A decreased their LDL-particle count by -213.9, (95% CI -70 to -357), P=0.001; LDL-cholesterol by -8.8 mg/dL, (95% CI of -1.4 to -16.3 mg/dL), P=0.007; and total cholesterol by -9.9 mg/dL, (95% CI of -1.8 to -18.1 mg/dL), P=0.001. There were no significant changes in triglycerides or HDL-cholesterol in either group.
Conclusion: A low-intensity dietary counseling intervention provided by the PCP in patients at risk for cardiovascular diseases as part of a routine visit for dyslipidemia produced clinically meaningful improvements in both diet and lipids of magnitude similar to changes reported with high intensity interventions.
- © 2013 by American Heart Association, Inc.